International Journal of Clinical & Medical Images

Clinical Image

Case Report: A 65-years-old man, occupied as framer and stock-man, living in rural area of Kerman, Iran, presented with chest pain (pleuritic and diffuse in both hemi-thorax), productive cough (without haemoptysis), fatigue, night sweets and weight loss from a month ago. He had no past medical history. Family history was negative. He was not cigarette smoker and opium or alcohol addict. He had no recent travel history. On physical examination, he had fever about 38°C and oxygen saturation about 90%. Lung auscultation revealed diffuse bilateral crackle. Routine laboratory data were all normal except for a mild leukocytosis. Chest X-ray (CXR) was taken (Figure 1). Chest Computed Topography (CT) was performed (Figure 2). Bronchoscopy and Trans-Bronchial Lung Biopsy (TBLB) (Figure 3) were done; unfortunately, before preparation of results of TBLB, due to patient deteriorated condition, we urged to reassess him with CXR (Figure 1-2).

Keywords: Invasive cavitary; Pulmonary lesion; Mucormycosis; Immunocompetent

Discussion

After chest CT, primary diagnosis was necrotizing pneumonia; therefore, Vancomycin, Meropenem and Levofloxacin prescribed. TBLB pathology (Figure 4) revealed Mucormycosis as diagnosis; therefore, therapy changed to Linezolid, Colomycin and liposomal Amphotericin B. Evaluation for any underlying disease (especially immunosuppression state), complete rheumatologic panel and viral markers for hepatitis and HIV are all negative. Due to deterioration of patient condition gradually, we urged to reassess with chest CT, which showed progression of cavitary lesions (Figure 5). Lastly, even with appropriate therapy, disease progresses gradually; disseminated intravascular coagulation was occurred; and, unfortunately, patient died after about 2 months.

Declaration of Interests: The authors declare that they have no competing interests.